二维超声斑点追踪成像评价多发性骨髓瘤患者右心室收缩功能的研究

Application of two-dimensional speckle tracking imaging in estimating right ventricular contraction in patients with multiple myeloma

目的:探讨二维超声斑点追踪成像(2D-STI)技术评价多发性骨髓瘤(MM)患者右心室收缩功能的临床应用价值。方法:选取40例初诊的MM患者,根据修订的国际分期系统(R-ISS)以Ⅰ期和Ⅱ期患者为B组,以Ⅲ期患者为C组;另选取健康体检者25例为对照组(A组),获取常规二维及右心室功能参数,2D-STI技术获取右心室整体纵向应变(RVGLS)。结果:C组右心室心肌做功指数(Tei指数)较A、B组增高(P<0.05),C组右心室面积变化率(FAC)、三尖瓣环收缩期峰值速度(S′)较A组减小(P<0.05)。与对照组相比,MM患者RVGLS绝对值均减小(P<0.05),且以C组减小最为明显(P<0.05)。MM患者β2-MG水平与RVGLS绝对值呈负相关(P<0.001),白蛋白与RVGLS绝对值呈正相关(P<0.01),B型钠尿肽(BNP)、肌酸激酶同工酶(CK-MB)与RVGLS绝对值均呈负相关(P<0.05)。结论:MM患者右心室收缩功能受损,随着临床分级的加重受损更加明显。2D-STI技术可以早期客观、敏感地评估MM患者右心室收缩功能的变化情况,帮助临床诊疗,改善预后。

Objective:To evaluate the clinical value of two-dimensional speckle tracking imaging(2D-STI)in evaluating right ventricular systolic function in patients with multiple myeloma(MM).Methods:Forty newly diagnosed MM patients were included,and divided into group B(stage I andⅡ)and group C(stageⅢ)according to disease severity graded by the revised international staging system(R-ISS).Another 25 healthy subjects were recruited in the control group(group A).The parameters of routine echocardiography and right ventricular function were collected,and the overall longitudinal strain of right ventricle(RVGLS)was obtained by 2D-STI technique.Finally,the above parameters were compared for the differences among groups.Results:Compared with group A and B,the right ventricular myocardial performance index(Tei)was increased in patients in group C.Right ventricular fractional area change(FAC)and tricuspid annulus systolic peak velocity(S′)were decreased in patients in group C compared to those in group A(P<0.05).By comparison with the control group,the absolute value of RVGLS was decreased in MM patients(P<0.05),and the decrease was dominant in group C(P<0.05).The level ofβ2-MG protein in MM patients was negatively correlated with the absolute value of RVGLS(P<0.001),yet the albumin level was positively correlated with the absolute value of RVGLS(P<0.01),and B-type natriuretic peptide(BNP)and creatine kinase isoenzyme(CK-MB)were negatively correlated with the absolute value of RVGLS(P<0.05).Conclusion:Impaired right ventricular systolic function was seen in patients with multiple myeloma,and the impairment tends to be more obvious with aggravation of clinical grade.2D-STI technology can be used to objectively and sensitively quantitatively evaluate the changes of right ventricular systolic function in MM patients at an early stage,which is helpful for clinical diagnosis and treatment of this entity and improving the prognosis of the patients.